Healthcare Provider Details

I. General information

NPI: 1831340355
Provider Name (Legal Business Name): ANTONIA L NAVARRO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY PHYSICIAN GROUP ONCOLOGY 4100 JOHN R
DETROIT MI
48201-2013
US

IV. Provider business mailing address

1560 E MAPLE RD SUITE 400-CREDENTIALING DEPARTMENT
TROY MI
48083-1138
US

V. Phone/Fax

Practice location:
  • Phone: 800-527-6266
  • Fax: 313-576-8381
Mailing address:
  • Phone: 800-527-6266
  • Fax: 313-576-8381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005405
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: